An Educational Initiative for Dubai School Nurses and Physical Education Teachers on the Management of Traumatic Dental Injuries.

The aim of this study was to assess the knowledge of school nurses and physical education teachers (SN and PE teachers) about the emergency management of traumatic dental injuries (TDIs) in schools and to measure the impact of education on their knowledge. A longitudinal prospective study based on a questionnaire survey completed by 68 SN and PE teachers at three time periods (prior to, immediately after, and 3 months-post-educational intervention). Pre- and post t-test and repeated measures (analysis of variance) were used to compare the three group means for the same participants (p < .05 was considered significant). Significant improvement in the knowledge score among participants was observed between the initial survey to immediately after the educational session and to 3 months after (p = .047). Significant improvement in the choice of immediately seeking attention after tooth avulsion was observed (p = .001). The initial knowledge deficiency about the emergency management of TDIs among SN and PE teachers was improved and sustained.

Oral health challenges facing Dubai children with Autism Spectrum Disorder at home and in accessing oral health care.

AIM: To investigate the challenges faced by Autism Spectrum Disorder (ASD) children and their families in Dubai from three different perspectives of dental care: oral care at home, oral care at the dentist and access to oral care, and to compare the results to their normally developing peers. MATERIALS AND METHODS: A case-control comparative study of 84 ASD and 53 healthy children attending special needs centres and schools in Dubai including siblings of the autistic children. Data collection was by a survey questionnaire completed by parents or guardians. RESULTS: More parents of ASD children compared to parents of healthy children reported difficulties across almost all oral care variables explored. The majority of ASD children's parents (83.3%) reported that their children need assistance in brushing their teeth compared with 15.4% of the healthy controls (p-value < 0.001). The ASD children's uncooperative behaviour increased during dental visits and significantly more parents (37%) rated their child's experience as negative compared with 9.5% among the parents of control children (p-value=0.006). The autistic children had visited a dentist mostly for extractions. CONCLUSION: This study indicates that autistic children in Dubai experience more challenges and barriers to oral care than their typically developing healthy peers.

Oral health problems in leukaemic paediatric patients in the United Arab Emirates: a retrospective study.

AIM: The aim of this study was to estimate the prevalence of oral health problems in leukaemic paediatric patients in the United Arab Emirates (UAE) and correlate it to the phase of chemotherapy. MATERIALS AND METHODS: Medical records of 120 paediatric leukaemic patients (age below 15 years) in the UAE were reviewed for the occurrence of oral health problems. Records from the three main hospitals that provide cancer therapy were accessed after obtaining the required permissions. RESULTS: The overall prevalence of oral health problems in leukaemic patients in our study is 60%. The most common oral health problem recorded in the patients&#x2019; records was oral mucositis and ulceration (52.4%) followed by dental caries and oral candidiasis accounting for 18.3% and 14.2% respectively. Other oral health problems recorded were gingivitis and gingival bleeding, herpetic gingivostomatitis, poor oral hygiene, and facial palsy. The peak occurrence of most oral problems was during phase IV (maintenance). Oral health problems were more common among patients who received treatment and follow-up locally rather than abroad. STATISTICS: Collected data were analysed using statistical software International Business Machines (IBM) Statistical Package for Social Sciences (SPSS, version 20, Chicago, SPSS Inc). Descriptive statistics were performed to describe the characteristics of the study population. The association between oral health problems and other risk factors was analysed using the Chi-squared test. A P-value of &#x3C;0.05 was considered statistically significant. CONCLUSION: This is the first study to describe oral health problems and its correlation to the phase of chemotherapy in leukaemic paediatric patients in the UAE. Oral health problems as a result of leukaemia and its management are both variable and unavoidable. Therefore, oral and dental care is of critical importance in maintaining the overall wellbeing of the patient before, during, and after treatment. This can be achieved by close liaison between the oncology and dental teams.

Dentists' knowledge of the guidelines of traumatic dental injuries in the United Arab Emirates.

AIM: This study aimed to assess general dental practitioners' (GDPs) knowledge within the United Arab Emirates (UAE) regarding the management of traumatic dental injuries (TDIs), and to compare their level of knowledge with that of paediatric dentists (PDs). METHODS: Dentists were asked to complete a two-part questionnaire (seven questions covering demographic data and 13 questions about trauma cases scenarios) in electronic and paper format. A total of 296 returned questionnaires were analysed to identify GDPs' knowledge in managing TDIs, and to compare the score of GDPs' knowledge with that of PDs'. RESULTS: Out of a total score of 13, the mean knowledge score (MKnS) for GDPs was 4.87±1.82 (only 37.5% of the 13 questions were answered correctly) while the MKnS of paediatric dentists was 5.56±1.47 (with 42.8% correct answers); both scores indicated poor knowledge and the difference was statistically significant (p=0.005). CONCLUSION: There was poor knowledge of TDIs among the surveyed UAE GDPs as well as the PDs, although PDs scored higher, indicating the need for further training.

Assessment of the knowledge of United Arab Emirates dentists of Child Maltreatment, protection and safeguarding.

AIM: Child safeguarding is society's responsibility. Dentists are uniquely positioned to recognise Child Abuse and Neglect (CAN) in dental practice and the wider society. The United Arab Emirates (UAE) introduced a child protection law in 2016. We aimed to assess the awareness of UAE dentists of child maltreatment, protection and safeguarding. Study Design A cross-sectional survey. MATERIALS AND METHODS: We surveyed 381 UAE dentists about the knowledge and practice of CAN and safeguarding issues using a self-administered anonymous questionnaire. Statistical analysis was carried out using Chi-square, t-test, ANOVA and Pearson's correlation test and statistical significance was set as p <0.05. RESULTS: Over 39 % (n=152) of the responders suspected CAN; male dentists suspected more CAN than females (p=0.015). Orthodontists, paediatric dentists (p<0.001) and female dentists (p=0.001) were more knowledgeable about diagnosing CAN. Paediatric dentists attended more CAN-related postgraduate training (p<0.001) than other specialties. Over 90% (n=346) believed that CAN should be addressed, 58.1% (n=224) and 54.1% (n=206) had CAN undergraduate and postgraduate training respectively but 53.5% (n=204) were unaware of local child protection guidelines. Dentists barriers to child protection reporting were; fear of family violence (59.6%, n=227), lack of knowledge of referral process (60.2%, n=228) and lack of diagnosis certainty (54.9%, n=206). UAE dentists qualified in Western and Asian countries had fewer barriers for child protection reporting (p=0.022) than the Arab and Gulf Cooperation Council qualified dentists. CONCLUSIONS: A large minority of UAE dentists suspected CAN. Factors influencing child protection reporting were identified. Dentists' gender, specialty, and country of qualification affected their knowledge of CAN and practice of safeguarding. Child protection training is recommended.

[Periprosthetic knee infection after a cat bite]. / Periprothetische Kniegelenkinfektion nach Katzenbiss.

BACKGROUND: Infections caused by Pasteurella multocida are extremely rare in arthroplasty. We report the case of a patient who was bitten by his domestic cat, causing an infection of his knee arthroplasty. DIAGNOSIS AND TREATMENT: The puncture of the knee resulted in putrid joint effusion. After removal of the knee prosthesis, infection with Pasteurella multocida was verified. We performed a two-stage revision combined with intravenous antibiotic therapy. DISCUSSION: Infections caused by cats and dogs should attract more attention especially as prosthesis material represents a significant "locus minoris resistentiae". Patients with domestic pets should be informed about this source of infection and possible complications. In the case of a bite, prompt and liberal antibiotic treatment should be administered.

Hall technique versus conventional preformed metal crowns: can paediatric dentists tell the difference on radiographs?

PURPOSE: Hall technique (HT) preformed metal crowns (PMCs) are allegedly oversized compared to conventional (C) PMCs. To investigate paediatric dentists' (PDs) perception of HT-PMCs and perception/ability to identify HT or C-PMCs on bitewings radiographs. METHODS: An online cross-sectional questionnaire including ten bitewings (five of each of HT/CPMCs) was sent to PDs across the globe. A PMC type score (from '10') was calculated. T test, Pearson's and Fischer's Chi-square, and Odd Ratios (OR) (p < 0.05). RESULTS: A total of 476 PDs from around the world responded. Most (97%) used PMCs in their practice. Most (98.7%) knew of, and 79% used HT-PMCs. A clear opinion shift, towards supporting HT, over time was noted (OR 11.154 [95% confidence interval (CI) 6.006-20.715]. A majority (67%) thought that HT/C-PMCs were similar radiographically. Only five PMCs were identified correctly [mean score 4.9 (± 1.73)]. A minority who thought that HT/C-PMCs were dissimilar scored higher than those who thought they were similar (5.31 ± 1.22; 4.68 ± 1.9, respectively, p < 0.00001). Nobody identified all ten PMCs. HT-PMCs were 4.63 times more identifiable than C-PMCs [(OR 24.857 CI 15.059-41.028) and (OR 5.361 CI 3.089-9.304)] for HT-PMCs and CP-MCs, respectively (p < 0.0001). CONCLUSIONS: PDs identified the PMC type in half of the bitewings. They perceived no clear radiographic difference between HT-PMCs and C-PMCs, but their chance of recognizing HT-PMCs was five times higher than C-PMCs. HT-PMC support was high.

Calcium- and ROS-mediated defence responses in BY2 tobacco cells by nonpathogenic Streptomyces sp.

AIMS: The early molecular events underlying the elicitation of plant defence reactions by Gram-positive bacteria are relatively unknown. In plants, calcium and reactive oxygen species are commonly involved as cellular messengers of a wide range of biotic stimuli from pathogenic to symbiotic bacteria. In the present work, we checked whether nonpathogenic Streptomyces sp. strains could induce early signalling events leading to defence responses in BY2 tobacco cell suspensions. METHODS AND RESULTS: We have demonstrated that nonpathogenic Streptomyces sp. OE7 strain induced a cytosolic Ca(2+) increase and a biphasic oxidative burst in the upstream signalling events, leading to defence responses in BY2 tobacco cell suspensions. Streptomyces sp. OE7 also elicited delayed intracellular free scopoletin production and programmed cell death. In agreement with scopoletin production, OE7 induced accumulation of PAL transcripts and increased accumulation of transcripts of EREBP1 and AOX genes that are known to be regulated by the jasmonate/ethylene pathway. Transcript levels of PR1b and NIMIN2α, both salicylic acid pathway-linked genes, were not modified. Moreover, Streptomyces sp. OE7 culture filtrates could reduce Pectobacterium carotovorum- and Pectobacterium atrosepticum-induced death of BY2 cells and soft rot on potato slices. CONCLUSIONS: New insights are thus provided into the interaction mechanisms between Streptomyces sp. and plants; Streptomyces sp. could be sensed by plant cells, and through cytosolic Ca(2+) changes and the generation of reactive oxygen species, defence responses were induced. SIGNIFICANCE AND IMPACT OF THE STUDY: These induced defence responses appeared to participate in attenuating Pectobacterium-induced diseases in plants. Thus, Streptomyces sp. OE7 could be a biocontrol agent against Pectobacterium sp.

Sleep-disordered breathing in children and adolescents seeking paediatric dental care in Dubai, UAE.

PURPOSE: This study aimed to evaluate the severity of high-risk SDB in children and adolescents seeking paediatric dental care. Sleep-disordered breathing (SDB) has many untoward consequences that may interfere with children's health and is associated with several risk factors. METHODS: In this cross-sectional study, the convenience sample included 65 healthy children and adolescents aged 7-16. High-risk SDB breathing was assessed using the Paediatric-Sleep-Questionnaire consisting of 22 questions. High-risk was defined as a positive response to 33% or more of the questions. The clinical examination included: tonsils' size, Body-Mass Index, orthodontic examination, and enamel defects. RESULTS: In this sample of 65 children with a mean age of 9.75 (± 2.60) years; 36 (55.4%) were boys, and 29 (44.6%) were girls. Overall, 12.3% of children in the sample were at high-risk of SDB, and this was significantly associated with tonsils' size (P = 0.001), Body-Mass Index (P = 0.03), Class-II molar relationship (P = 0.03), and posterior crossbite/s (P = 0.02). CONCLUSIONS: This study suggested that approximately 12% of the sample studied were potentially at risk of SDB. Tonsils' size, Body-Mass Index, Class-II molar relationship, and posterior crossbite/s were positively associated with the risk of SDB. Therefore, the importance of investigating the risk for sleep-disordered breathing should not be disregarded.

A 24-month retrospective study of preformed metal crowns: the Hall technique versus the conventional preparation method.

PURPOSE: Conventional and Hall Technique (HT) Preformed Metal Crowns (PMCs) are used for treatment of carious primary molars. The aim was to evaluate the clinical and radiographic success of conventional and HT PMCs in a postgraduate dental setting. METHODS: A retrospective study using patients' electronic case-notes and radiographic images of carious primary molars treated with either conventional or HT PMCs was conducted to assess clinical and radiographic success/failure. A Kaplan-Meier curve was used to assess PMC survival. RESULTS: 187 PMCs (110 HT and 77 conventional) in 65 children (34 females and 31 males) at 6, 12, 18 and 24 months were assessed. At 24 months, the success rates of conventional and HT PMCs were 97.6% and 93.5%, respectively. Two HT (perforated/abscessed) and four conventional (abscessed) PMCs failures occurred. There was no significant difference in success/failure (p = 0.362) at 12 months, but the HT was more successful at 24 months (p = 0.002) with similar survival times for both methods. CONCLUSION: HT and conventionally placed PMCs, when placed in a postgraduate paediatric dentistry setting, were clinically and radiographically very successful at 6, 12, 18 and 24 months post operatively with a slightly higher success of the HT at 24 months.

Child maltreatment in Dubai and the Northern United Arab Emirates: dental hygienists and assistants' knowledge.

PURPOSE: Dental assistants (DAs) and hygienists (DHs) should play an active role in the detection and reporting of child abuse and neglect (CAN). We aimed to investigate CAN knowledge of DAs and DHs in the United Arab Emirates (UAE) and some of the inhibiting factors to the process of CAN reporting. METHODS: A cross-sectional study design was utilized. We surveyed 186 DAs and DHs using a previously validated self-administered anonymous CAN knowledge questionnaire. Statistical analysis was performed using χ2-square, Fisher's exact test, t test/Mann-Whitney, and a ROC curve (p < 0.05). RESULTS: Among 186 DAs and DHs surveyed, satisfactory knowledge of CAN was demonstrated by 50.5%. DAs scored a significantly higher score of knowledge compared to DHs (p = 0.03). The most reported CAN referral inhibiting factor was "being afraid to get in trouble with parents". The recognition of a child with special needs and parents missing multiple appointments as risk factors for CAN was significantly higher in the DAs compared to DHs (p = 0.04, p = 0.024, respectively). Awareness of local laws was related to CAN knowledge in DAs (p = 0.012) and DHs (p = 0.008). CONCLUSION: The lack of appropriate knowledge regarding CAN necessitates a clear reporting process and better education for DAs and DHs in the UAE.

Children's dental anxiety (self and proxy reported) and its association with dental behaviour in a postgraduate dental hospital.

PURPOSE: Child dental anxiety (CDA) and uncooperative dental behaviour are common. We aimed to assess the prevalence of CDA (self- and proxy- reported) in the United Arab Emirates (UAE) children related to their dental behaviour. METHODS: Data were collected from 312 questionnaires obtained from 156 parent/child (mean age 9.95 ± 2.17 years) pairs attending a postgraduate dental hospital. Demographics, self/proxy- reported CDA scores via a six-question, five-point Likert scale, of the Modified CDA Scale-faces version (MCDAS-f: where ≥ 19 was severe CDA) and Frankl Behaviour Rating Scale (FBRS) scores were compared and analysed. Chi-square test, Pearson's correlation, Kappa- coefficient, one-way ANOVA and independent t test statistical analysis were used (p < 0.05). RESULTS: The prevalence of self and proxy severe CDA was 22.4% (n = 35) and 33.3% (n = 52) respectively, with 9% (n = 14) being dentally- uncooperative. In both groups, extractions caused the highest CDA followed by injections and fillings (p < 0.001). The mean scores for self-reported/proxy-reported CDA were 15.02 (± 4.90)/15.70 (± 6.07) respectively. There was a positive linear correlation between self- and proxy- reported CDA scores and a negative linear correlation between self/proxy- reported CDA scores and the FBRS (p < 0.001). Self/proxy concordance of severe anxiety/none-to-moderate- anxiety was fair (68.6%, kappa = 0.23, p = 0.003). Both self/FBRS and proxy/FBRS concordance of severe anxiety/none-to-moderate- anxiety/behaviour was fair (78.8%, kappa = 0.23, p = 0.001) and (71.8%, kappa = 0.22, p < 0.001) respectively. CONCLUSIONS: Considering the limitations of the present study in a UAE child population sample, the prevalence of CDA from extractions, injections and fillings was 22.4% (self- reported) and 33% (proxy reported). There was fair agreement between child- self and parent- proxy- reported CDA. Increased CDA led to uncooperative dental behaviour.

Fluoride concentration of commercially available infant formulae in the United Arab Emirates.

PURPOSE: To assess fluoride concentration in infant formulae commercially available in the United Arab Emirates (UAE) and compare the measured levels of fluoride to the reported ones on the label. METHODS: Twenty-four different infant formula samples collected from retailers in the UAE market were tested for the fluoride content using ion-selective electrode method. Statistical analysis was performed using descriptive statistics and Mann-Whitney test. P < 0.05 was considered significant. RESULTS: The mean fluoride content of baby formula samples collected was 0.19 ppm (range 0-0.4 ppm). All tested samples of formulae were manufactured outside the UAE. Following the daily recommended manufacturer's preparation guidelines, tested formulae had a range of 0-0.35 mg of fluoride per day, a concentration below the average daily recommended fluoride intake for a 6-month-old infant with an average weight of 7.2-8 kg (0.36-0.42 mg fluoride). Out of the 11 samples where the fluoride content was mentioned on the label, only two were verified to have a somewhat accurate reported concentration when comparing the concentration mentioned on the label with our test results. Out of the 13 samples with no fluoride concentration mentioned on the label, three were found to have no fluoride (Neocate, Isomil, Aptamil), while the remainder (10) contained fluoride with a range of (0.1-0.4 ppm). CONCLUSIONS: All the UAE available infant formulae tested had lower than the maximum daily recommended dosage of fluoride. Many labeling inaccuracies were observed. Accurate labeling guidelines are recommended.

Assessment of paediatric dental guidelines and caries management alternatives in the post COVID-19 period. A critical review and clinical recommendations.

PURPOSE: The first aim of this paper is to provide dental professionals caring for children and adolescents during and after the COVID-19 pandemic with a reference to international dental guidelines. The second aim is to suggest minimally invasive treatment alternatives for caries management, minimising the risk of viral cross-infection and offering a safer clinical environment. METHODS: An evidence-based pertinent literature search of different electronic databases was performed in addition to leading global dental authorities, royal colleges, and programmes. RESULTS: All guidelines released in response to COVID-19 centred around minimising Aerosol Generating Procedures (AGP) impacting the provision of regular dental treatment of paediatric patients. There was an emphasis on triaging and only treating emergency and urgent cases. Special attention was given to medically compromised children in the guidelines. Detailed guidelines for the dental environment and equipment were given. This paper also summarised the relevant evidence-based guidelines for the use of non-invasive and minimally invasive caries management techniques. CONCLUSION:  Specific recommendations for dental management of paediatric patients during and in the post-COVID-19 era are suggested. Minimisation of AGP procedures, and case-based selection of biological, non-invasive or minimally invasive methods are recommended.

United Arab Emirates dentists' perceptions about the management of broken down first permanent molars and their enforced extraction in children: a questionnaire survey.

PURPOSE: The broken down first permanent molar (BDFPM) is common in children. Enforced extractions of first permanent molars (EExFPMs) guidelines were published in the United Kingdom (UK) in 2014. We aimed to assess the knowledge and practice of dentists in the United Arab Emirates (UAE) of BDFPMs in children in light of the guidelines. METHODS: A cross-sectional sample of UAE-based dentists treating children completed a self-administered questionnaire covering; knowledge and practice of the principle of EExFPMs; to whom dentists would refer in case of BDFPMs; knowledge of the ideal age for EExFPMs (8-10 years) and finally actual awareness of the EExFPMs guidelines. Chi-square tests (p < 0.05). RESULTS: A total of 199 questionnaires were completed (total return rate was 66.33%). There was no agreement on how to deal with a scenario of BDFPMs. Over 85% majority believed in saving BDFPMs rather than extracting them but 89% would consult/refer to other specialists. Whilst 51% of the participants had never carried out EExFPMs in children, 69% were aware of the EExFPMs concept and 61% knew the ideal timing of a lower FPM extraction. More than 82% were unaware of the actual UK EExFPMs guidelines. Paediatric dentists would consider EExFPMs more than other groups (p = 0.007). CONCLUSION: In the UAE dentist sample surveyed, there was a preference for preserving BDFPMs rather than extracting them in children, despite knowing when the ideal time for extraction was. Training background and specialty were influencing factors. There was a lack of awareness of the actual UK 2014 EExFPMs guidelines.

A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States.

OBJECTIVES: The aim of the study was to evaluate the prevalence and severity of dental caries in pre-school children in the Gulf Cooperation Council (GCC) area. METHODS: A search of literature was conducted to identify articles of dental caries in primary dentitions published during the period from January 1st, 1992 to June 30th, 2016. PubMed, Google Scholar search, and hand searching of journals was conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms. RESULTS: Out of a total of 193 studies that fit the initial inclusion criteria, 159 studies were further excluded. Only 34 studies were included in the systematic review and meta-analyses. The overall mean dmft in the primary teeth was 5.14 with prevalence of 80.9% in the GCC area. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 2538.501 (df = 21) and I2 value of 99.17%. However, the funnel plots showed symmetrical shape at the bottom in both dmft and prevalence studies indicating absence of publication bias, which was also confirmed by insignificant result of Egger's regression statistical test (Egger's test P = 0.179-0.358). CONCLUSION: Caries in the primary dentition in the GCC States was high both in terms of mean dmft (5.14) and prevalence (80.95%).

Oral health status of pre-school children of incarcerated mothers in United Arab Emirates prison nurseries and oral health knowledge and attitudes of their caregivers.

AIM: To evaluate the oral-health of preschool-children of incarcerated-mothers at nine United Arab Emirates (UAE) prison-nurseries and assess the oral-health knowledge and attitudes of the prison nurseries' caregivers. STUDY DESIGN: Cross sectional comparative study. METHODS: A total of 128 and 254 preschool children formed the study and control groups respectively. All were examined clinically for dental caries using the dmft score and oral health and hygiene status indices. Knowledge and attitudes of all caregivers (n = 45) at prison nurseries were assessed using an interview questionnaire. RESULTS: The prevalence of caries was not significantly different between the two groups with 89.9% [mean-dmft 4.97 (± 3.61)] in the study group and 92.1% [mean-dmft 4.48 (± 3.60)] in the controls. Oral-hygiene in the control group was better with 18.2% having good oral-hygiene compared to 6.2% in the study-group. Oral-health knowledge and attitude of the caregivers of prison nurseries were not satisfactory. CONCLUSIONS: Despite the non-significant difference in the caries prevalence between the study and control groups, oral hygiene and care level of vulnerable-children of incarcerated-mothers were significantly poorer. Prisons' caregivers had poor knowledge and attitude of dental health matters.